<form action="requestAccess.php" method="post">
 <p>Product: <input type="text" name="productid" /></p>
 <p>Your UDID: <input type="text" name="udid" /></p>
 <p>EMail: <input type="text" name="email" /></p>
 <p>Message (if you haven't typed in who you are, please type some intro about you, your blog so that, it easy for the user to approve your device): <input type="text" name="message" /></p>
 <p><input type="submit" /></p>
</form>